BVA9510897
DOCKET NO. 91-51 261 ) DATE
)
)
On appeal from the decision of the
Department of Veterans Affairs Regional Office in Baltimore,
Maryland
THE ISSUE
Entitlement to service connection for a psychosis.
REPRESENTATION
Appellant represented by: Cathy Surace, Attorney at Law
WITNESS AT HEARING ON APPEAL
Ellen McDaniel, M.D.
INTRODUCTION
This matter came before the Board of Veterans' Appeals
(Board) on appeal from a rating decision of May 1990 of the
Baltimore, Maryland, Regional Office (RO) of the Department
of Veterans Affairs (VA). The veteran's military service
extended from September 1979 to December 1983.
The case was remanded by the Board in February 1992 for
further development. The requested development has been
completed and the case has been returned to the Board for
further consideration.
In July 1985, the RO denied service connection for a
psychiatric disorder. The veteran filed a timely notice of
disagreement with that rating action and was furnished a
statement of the case in October 1986. She did not timely
appeal the statement of the case, and the July 1985 rating
action became final. The Board has determined that new and
material evidence has been submitted to reopen the claim for
service connection for an acquired psychiatric disorder.
Inasmuch as we have also determined that it would be in the
veteran's best interest to proceed at this level with a
decision on the merits, we will proceed with a de novo review
of the claim at this time.
In September 1994 the veteran executed an authorization to be
represented by the Maryland Disability Law Center.
Cathy Surace, Attorney at Law, is shown by correspondence,
dated in March 1995, to be associated with that organization.
Ms. Surace is recognized as the appellant's representative
pursuant to the provisions of 38 C.F.R. § 20.603(c) (1994).
She appeared on the veteran's behalf at an April 1995 Board
hearing.
CONTENTIONS OF APPELLANT ON APPEAL
The appellant and her representative contend that the RO
committed error in not granting service connection for her
acquired psychiatric disorder because it did not take into
account or properly weigh the medical evidence of record. It
is contended that symptoms of the veteran's currently
manifested psychiatric disorder, now diagnosed as
schizophrenia, did develop during active service and were
manifested during active service and within the initial post
service year.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims file.
Based on its review of the relevant evidence in this matter,
and for the following reasons and bases, it is the decision
of the Board that the evidence is in favor of the grant of
service connection for a psychosis.
FINDING OF FACT
Paranoid schizophrenia developed during service.
CONCLUSION OF LAW
Paranoid schizophrenia was incurred in peacetime service.
38 U.S.C.A. §§ 1131, 5107(a) (West 1991).
REASONS AND BASES FOR FINDING AND CONCLUSION
The pre enlistment examination reveals no pertinent defects.
Service medical records commencing in July 1983 reveal a
psychiatric evaluation which concludes with an assessment of
"immature behavior." However, the veteran's thinking was
described as slightly disorganized and it was indicated that
she might possibly be responding to auditory stimuli.
Subsequent military clinical records refer to the existence
of a personality disorder. It was indicated that the veteran
was discharged from service due to unsatisfactory
performance.
The veteran was hospitalized by the VA from December 1984 to
April 1985. A personality disorder was diagnosed. However,
it was indicated that she was admitted to the hospital
following an incident where she set fire to the mattress of
her sister's bed. During a portion of the hospitalization,
she was maintained on Haldol and Cogentin, and there was a
serious question of whether she was, at various times,
responding to auditory hallucinations.
During VA hospitalization from May 1986 to June 1986, a
personality disorder was again diagnosed. Her behavior was
described as manipulative and it was the opinion of the
treating physicians that she was not hallucinating. It was
indicated that she was taking medication for mood swings.
Private clinical records reflecting psychiatric treatment in
February 1987 and thereafter, record a consistent psychiatric
diagnosis of schizophrenia.
E. G. McDaniel, M.D., reported in September 1989 that, from
1986 to 1987, schizophrenia was diagnosed by physicians at
two different hospitals. The report reveals that
Dr. McDaniel completely reviewed copies of service and post
service medical records referable to the veteran. She
expressed the opinion that individuals with personality
disorders demonstrate the same pathology over a life span, if
untreated. Typically, the symptoms of a personality disorder
are manifested in the context of interpersonal relationships,
and the mental status examinations of such individuals are
usually unremarkable. She noted that the veteran performed
admirably for the first three years of her service and then
had a very well documented and well delineated deterioration
in her behavior, in 1983. She noted that erratic and
impulsive behavior, impaired cognition, religiosity,
grandiosity, hostility and social withdrawal were all noted
on repeated occasions. She further referred to the fact that
the veteran was described as exhibiting slightly disorganized
thinking and an inappropriate affect and the issue of the
possibility of auditory hallucinations was raised.
Dr. McDaniel then went on to note that, from the time of the
veteran's discharge from service in December 1983, she was
never again able to function independently in the community.
The physician felt that this was more typical of a
schizophrenic illness then of a personality disorder. Dr.
McDaniel then went on to discuss the incongruity between the
diagnosis of a personality disorder during the period of VA
hospitalization from December 1984 to April 1985 and some of
the clinical findings described during that period of
hospitalization. These findings, she noted, included
hallucinations, the presence of a flat affect, social
withdrawal, hostility, projection, poor insight and limited
judgment, and noncompliant behavior. She then discussed the
findings in 1986 where she reported schizophrenia had been
diagnosed at a private hospital. She concluded by noting
that with a reasonable degree of medical certainty, it was
her opinion that the veteran currently suffered from chronic
paranoid schizophrenia and that the symptoms of this disorder
were first manifested in 1983, when her behavior underwent a
very well defined deterioration.
At an appellate hearing before this member of the Board in
April 1995, Dr. McDaniel testified in the veteran's behalf.
Her testimony essentially supported the September 1989 letter
and she went on to amplify about various aspects of the onset
of the veteran's psychosis. She was still of the opinion
that the psychosis began, in service, in 1983. This member
of the Board found her testimony to be credible and
exceptionally probative. Dr. McDaniel is a psychiatrist by
profession.
We find, based on the service and post service medical
records and the hearing testimony described above, that
paranoid schizophrenia developed in service in 1983. A
proper basis is afforded for the grant of service connection
for a psychosis.
(CONTINUED ON NEXT PAGE)
ORDER
Service connection for a psychosis is granted.
BRUCE E. HYMAN
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991), a decision of the Board of Veterans' Appeals granting
less than the complete benefit, or benefits, sought on appeal
is appealable to the United States Court of Veterans Appeals
within 120 days from the date of mailing of notice of the
decision, provided that a Notice of Disagreement concerning
an issue which was before the Board was filed with the agency
of original jurisdiction on or after November 18, 1988.
Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402
(1988). The date which appears on the face of this decision
constitutes the date of mailing and the copy of this decision
which you have received is your notice of the action taken on
your appeal by the Board of Veterans' Appeals.